van der Velden J
Afdeling Gynaecologie, Academisch Medisch Centrum, Amsterdam.
Tijdschr Gerontol Geriatr. 1997 Dec;28(6):272-6.
Invasive squamous cell cancer of the vulva is predominantly a disease of older women. Current standard treatment entails a radical local excision with bilateral groin node dissection through separate incisions. In individual patients with superficially invasive small tumors the groin dissection can be omitted and in patients with well lateralized tumors a contralateral groin dissection is not always necessary. In the past the 'en bloc' resection of the vulva and groin nodes was the standard treatment for every patient. With the introduction of the above mentioned modifications, resulting in less morbidity, more older patients can now get the standard treatment. A retrospective analysis of all patients with vulvar cancer registered in a region in the Netherlands was carried out. The objective was to determine the referral pattern and the number of patients who received standard treatment. Sixty-seven of the 138 patients were not referred to a gynecological oncology center. Of this group the patients with squamous cell cancer (n = 36) 80% did not get standard treatment. Compared with the group of patients who did get standard treatment, these patients were older (median 81 years) and had an earlier stage of the disease. A higher than expected recurrence rate of 46% and a lower than expected survival rate of 68% was found. During follow-up several patients were found to be medically fit enough to undergo extensive salvage surgery for this recurrence. From the results of this study it can be concluded that deviation from standard treatment in early vulvar cancer only on the basis of old age results in decreased survival. Only the performance status of the patient combined with clinical and pathological prognostic variables should be used to decide what treatment is best for which patient.
外阴浸润性鳞状细胞癌主要是老年女性的疾病。当前的标准治疗方法是通过单独的切口进行根治性局部切除并双侧腹股沟淋巴结清扫。对于个别浅表浸润性小肿瘤患者，可以省略腹股沟清扫，对于肿瘤定位良好的患者，不一定总是需要进行对侧腹股沟清扫。过去，外阴和腹股沟淋巴结的“整块”切除是每位患者的标准治疗方法。随着上述改良方法的引入，发病率降低，现在更多老年患者能够接受标准治疗。对荷兰某地区登记的所有外阴癌患者进行了回顾性分析。目的是确定转诊模式以及接受标准治疗的患者数量。138名患者中有67名未被转诊至妇科肿瘤中心。在这组患者中，鳞状细胞癌患者（n = 36）有80%未接受标准治疗。与接受标准治疗的患者组相比，这些患者年龄更大（中位年龄81岁）且疾病分期更早。发现复发率高于预期，为46%，生存率低于预期，为68%。在随访期间，发现几名患者身体状况适合接受针对这种复发的广泛挽救性手术。从这项研究的结果可以得出结论，仅基于年龄而偏离早期外阴癌的标准治疗会导致生存率降低。只有结合患者的身体状况以及临床和病理预后变量，才能决定哪种治疗方法最适合哪位患者。
